The Sweetest Poisons: Preston Sprinkle's "Embodied" Chapter 3: Varieties of Trans. A Review

This is the fifth installment in my series reviewing Preston Sprinkle's book Embodied: Transgender Identities, the Church, & What the Bible has to Say. Click HERE for the Intro to this series where I discuss my thematic concerns with the book and for an index for the full series.

A transgender person is anyone whose gender identity does not align with the sex they were assigned at birth.

I need to foreground the standard definition of what the term transgender means before we launch into this chapter because this is where all the prep work Preston Sprinkle did in the previous two chapters, introducing the subject and defining a bunch of terms in ways that suit his arguments, really starts to pay off in tragically misleading ways. The definition above doesn't actually conflict with the one Sprinkle provided at the beginning of Chapter 2—an umbrella term for the many ways in which people might experience and/or present and express (or live out) their gender identities differently from people whose sense of gender identity is congruent with their biological sex—but keeping the original front and center will do a lot to show how far Sprinkle wants to drift from it. 

We also need to keep in mind Sprinkle's deployment of trans* with the asterisk which he is using as a sort of larger umbrella than the term transgender above:

...some people put an asterisk after the word trans, styling it as trans*, when they want to use it as a broad umbrella term to include a whole range of identities that aren't strictly transgender, such as nonbinary, genderqueer, and the like. I'll do the same in this book.

As I referenced in the intro to this series, Sprinkle's choice to use trans* with the asterisk is decidedly non-standard and was not standard in 2021 when the book was published. I would love to know who the "some people" from the above definition actually are; unfortunately Sprinkle didn't provide any citation for that portion of Chapter 2. I was able to locate trans* in 2 out of 5 online glossaries of LGBTQ+ related terms and in neither of them was there an indication that trans* indicates identities that don't already fall under the trans or transgender umbrella. The closest thing to that claim was the observation that using trans* rather than trans does a better job of expressing inclusion of certain non-binary identities. That may be where Sprinkle got the idea but if so then he has made a leap from the claim that one term is better at expressing an inclusivity that both are intended to express, to the claim that one expresses a greater degree of inclusivity than the other. In effect he has taken the step of reifying a distinction that is not intended by any original users of the term.

Sprinkle structures Chapter 3 around brief explanations of his different categories of "trans*" people. So far as I have been able to find this taxonomy is unique to Sprinkle.

So Let's buckle up dive in to his categories:

Gender Dysphoric Trans*

Sprinkle is, at some level at least, aware of the fact that gender dysphoria is a particular experience, one for which transition is really the only recognized treatment. Sprinkle is perfectly correct to observe that "some trans*-identified people experience gender dysphoria, and some don't" but he goes on to assert that "For those who do, there are two broad categories: early-onset gender dysphoria and "late-onset gender dysphoria" which is technically true since trans people who experience gender dysphoria do begin experiencing it at a variety of ages and the late vs early onset has been used in the past but then there are a lot of ways that people who experience gender dysphoria can be divided into categories (severity of the dysphoria, birth assigned sex, those who do and do not decide to transition etc...) it is worth noticing now that this particular taxonomy happens to serve his purpose later in the chapter.

Regardless, Sprinkle goes on to focus on early-onset gender dysphoria and immediately spreads some misinformation. His concluding paragraph on the topic claims "And for most kids [gender dysphoria] goes away. According to all available studies done on the persistence rate of dysphoria in kids, 61 to 88 percent of early-onset dysphoria cases end up desisting; that is, the dysphoria goes away over puberty". He does have a footnote for this assertion and in it he admits that "this 'desistance' rate has been the subject of much controversy," (which already calls into question his main text claim about "all available studies") and then cites a paper justifying conversion therapy for trangender kids from his own organization his own organization and a blog post from James Cantor, a notoriously transphobic psychologist whose "work" around transgender people has been critisized by multible mainstream medical associations. Both cite a number of studies but this 2016 piece by Brynn Tannehill demonstrates just how horribly flawed the assumptions, methods, and processes that went into making up that "61-88%" desistance rate are. To hand wave those serious methodological flaws as "controversy" and to hide even that away in a footnote and away from the main text is, frankly, misleading to the point of being dishonest. Further, since the release of Sprinkle's book, studies have been released setting the number at a whopping 6% of children who present with gender dysphoria and go on to desist, making the audacity of Sprinkle's claims and the severely biased nature of his "research" rather starkly apparent. I would very much encourage you to read more about this HERE (this video is a nice tl;dr by the author) and decide for yourself whether or not Preston's numbers are accurate and whether the language and certainty he projects in the main text are justified.

Non-Gender Dysphoric Trans* 

Before we get into what Sprinkle has to say in this section I want to be clear that "experiencing vs. not-experiencing gender dysphoria" is not a way in which trans people categorize ourselves. The fact of the matter is that on the one hand it is true that someone does not have to experience dysphoria to be trans—to be trans is to have a gender identity which doesn't align with the sex you were assigned at birth, whereas gender dysphoria is an experience of distress that is caused by said misalignment, so if you are trans, you don't become less so by not suffering as a result—and on the other hand gender dysphoria manifests in many different ways and many people who do experience dysphoria do not recognized that that is what they are experiencing for quite a while.

So with that as background, Sprinkle starts this section off in what is becoming typical of his misleading-while-giving-himself-a-technical-out method: he quotes a trans YouTuber claiming to be "1000% transgender" and also to identify 1000% as the gender he was assigned at birth. In the footnote to this strange claim, Sprinkle allows that the YouTuber in question later retracted that statement but Sprinkle apparently didn't think that fact deserved a place in the main text. More troubling, he goes on to use that retracted quote as a jumping off point to start talking about a "'self-ID' perspective" in which "if you say you're trans*, then you're trans*" which itself is a starting point for him to begin discussing trans-medicalism (without naming it). It is unclear what the retracted quote has to do with dysphoria or what purpose Sprinkle thinks it is serving in his book and the Sprinkle's claims about self-ID are, again, a severe misrepresentation of what trans people actually think and say. The claim "if you say you're trans then you're trans*" does not, when spoken by the community, mean that speaking the phrase "I am trans" will magically grant a status of transness. It means that people should not be required to demonstrate or perform misery or suffering in order to be recognized as trans. Some trans people, for instance, do not experience gender dysphoria but they do experience gender euphoria when they are able to live into their actual gender identity. It means that each person is in the best/only position to know whether the sex they were assigned at birth aligns with their gender identity. 

Sprinkle ends the section by misrepresenting Natalie Wynn as saying that performance is all there is to gender, and then citing Blaire White as disagreeing. Sprinkle doesn't provide a citation for either woman so his claim that Natalie Wynn "says that if you live like a woman, then you're a woman" is hard to verify but, as someone who has watched most (all?) of her video essays I can very safely say that that quote does not represent anything like the full complexity of Wynn's views on what constitutes womanhood or transness. Meanwhile Blaire White is, for sure, a transmedicalist but whose views can't really be said to represent anything close to a consensus or even established position in contemporary transgender discourse (popular or academic). Sprinkle ends by asking (and not answering) "Which one is right? And why? What does it mean to be trans*" an odd question given that he has already provided his definition. 

Trans* Experience Vs. Trans* Ontology

Sprinkle does...a lot with this section of the chapter. It is worth reiterating that he purports to be descriptive in each of these sections and does not write as though he were making an argument but as though he were reporting on the phenomenon of transness. That mode of writing allows him to wildly over-represent extremely minority accounts as nonetheless representative of trans people. For instance, in this section he spends most of his time talking about two people: Kat and Dan. Kat is a woman who identifies as transgender but also as the sex she was assigned at birth. She identifies as transgender because she experiences gender dysphoria but, for religious reasons, has chosen not to transition or to identify as the man or non-binary person she actually experiences herself to be. (Sprinkle does not provide all of this information but he interviewed a Kat on his podcast and I am working from that. 

Meanwhile the picture that Preston paints with "Dan" (I was unable to determine who Sprinkle is talking about) is both representative of what people generally actually mean by "transgender" and is also rather wildly revealing of Preston's actual beliefs given that he introduces "Dan" by misgendering her and then switches to she/her only after punting on the question of pronoun usage. 

We will have to wait for the next chapter before Sprinkle actually weighs in with anything like an argument on this question so before moving on I will note again that, in this section Sprinkle presents as representative, a view that is—at best—such an overwhelmingly minority view that most transgender people would find it baffling—it wouldn't even register as a common mistake or dispute.

ROGD Trans*

Sprinkle takes two paragraphs to introduce this as a concept then punts to Chapter 10 granting, at least, that "Lots of discussions (and heated debates) surround ROGD" (Rapid Onset Gender Dysphoria). It is worth noting that he also identifies the derogative term trans trender in this section and objects to it's use not because it "can feel like it's invalidating someone's experience" as such but because that "is never a great way to start a relationship. Sprinkle's concern is evangelistic and propagandistic, rather than person-centered. He also includes the claim that "there does seem to be a good deal of evidence that social influences are one reason some (perhaps many) teenagers and young adults identify as trans*"  Which, for any reasonable definition of "a good deal of evidence" is a false claim since the only study which has even purported to support ROGD was so methodologically flawed that the journal which published it chose to take it down for amendments and to moderate its conclusion.

I will engage with Sprinkle's actual arguments and debate in my response to Chapter 10 so for now here are several articles pointing out the flaws in the ROGD "theory":

• Julia Serano: Everything You Need To Know About Rapid Onset Gender Dysphoria
• The Journal of Pediatrics: Do Clinical Data from Transgender Adolescents Suppport the Phenomenon of "Rapid Onset Gender Dysphoria"?
  
• Medical News Today: What is Rapid Onset Gender Dysphoria?

And here is an excellent podcast episode with a case study of the harm caused by ROGD
Seduction of Rapid Onset Gender Dysphoria

Trans* Detransitioners  

Detransitioners do exist and they absolutely need to be heard. Sprinkle reasonably referrs to detransitioners (people who had transitioned to at least some extent who choose to go back to living as their assigned gender) as "another group of (former?) trans* people" since the degree to which detransitioners identify as trans is significantly varied. After that, though, Sprinkle goes on to list potential reasons for detransition and comes up with: dissatisfaction with "the operation"1, depression and anxiety not going away after transition, and fading ROGD. He provides no citation though so I looked it up. In fact, in 2021 the NIH released a significant study on the reasonons for detransition and found that:

In this national study, 13.1% of TGD respondents who had ever pursued gender affirmation reported a history of detransition. To our knowledge, this is the first study to systematically examine reasons for detransition in a large national sample of TGD adults. The vast majority of participants reported detransition due at least in part to external factors, such as pressure from family, nonaffirming school environments, and sexual assault. External pressures such as family rejection, school-based harassment, lack of government affirmation, and sexual violence have previously been associated with increased suicide attempts in TGD populations.

credit Sophie Labelle @AssigneeGarcon

 Note that Sprinkle's three reasons don't appear as any of the major reasons for transition. In fact the reasons Sprinkle highlights account for, at most, 18% of reasons for detransition while a lack of social/medical/familial/financial  support (which, I would argue, Sprinkle is contributing to here) account for the "vast majority" of cases. That is not the impression that Dr. Sprinkle conveys in this
short section and it is well worth asking why not. Also, while that study was published after Dr. Sprinkle's book he had access to similar data in one of the largest ever surveys of transgender people published by the National Center for Transgender Equality which found that only 9% of respondents had detransitioned for any of the reasons in Sprinkle's list while, again, the vast majority of detransitioners cited a lack of family/social/medical/financial support. 

Autogynephilic Trans*

This isn't a thing. Sprinkle does allow that "it doesn't exist and you're transphobic if you say it does" is a position that people take on this topic but, as we have seen him do several times already, he uses format and insinuation to give the impression that autogynephilia has far more legitimacy that it. in fact does. First, note that he conjoins "autogynephilia doesn't exist" with "an you're transphobic if you say it does" thereby putting everyone to whom the idea sounds even vaguely plausible on the defensive against any argument against the existence of autogynephilia. In this section Dr. Sprinkle provides a definition of autogynephilia as a term which "describes an experience where a biological male is erotically aroused at the thought of himself as a female" which isn't quite accurate. The term in fact was developed by Ray Blanchard as a category of paraphelia (think kink or fetish) in which a man is turned on at the thought of himself as a woman, thus when people say that "autogynephilia doesn't exist" they do not mean, as Sprinkle assumes, that no man (or trans woman) has ever been turned on by thoughts of being a woman, they mean that autogynephilia is not a paraphilia, nor is it a category of trans woman. You see the problem? Sprinkle uses the weak defition (the experience of being aroused at a particular concept) as his defintion but they goes on to act as though people identifying with that experience (Sprinkle cites two friends of his and two other individuals who identify with autogynephilia) as supporting the claims of people who use the hard definition of autogynephilia as a paraphilia. He is equivocating. 

Spinkle makes the rather strong statement in this section that "based on everything I've read and the people I've talked to, I believe without a doubt that some trans* people are autogynephilic" which he then supports with reference to the two friends one of whom, he admits, doesn't even experience "autogynephilia" as something erotic—which is rather the whole deal when it comes to any traditional "hard" definition of autogynephilia.

OK so I had better explain a bit more about what autogynephilia purports to be and why I opened this section declaring that it "isn't a thing". First I need to state that autogynephilia isn't a thing because every major psychological association rejects it both as a legitimate category of trans person and as a diagnosable paraphilia. Generally one runs into autogynephilia being proposed either as a sort of alternative to "real" transness, or as an argument that trans-ness generally is nothing more than an elaborate fetish. The former is rather personally frustrating to me as it was my own youthful exposure to the autogynephilia-as-fake-transness idea that persuaded me for over two decades that I was "not actually trans".

The core problem, in both instances (autogynephilia as a category of trans women and autogynephilia as a paraphilia) is that cis women are also routinely aroused in ways that involve understanding and imagining themselves as women. It is actually relatively rare to find a cis woman for whom imagining herself as a woman is not at least a part of her erotic fantasy life which means that when a trans woman finds that thinking of herself as a woman is a component of her erotic fantasy life she is just...experiencing the standard fantasy life of a woman. 

Sprinkle has to have been aware of this (prior to the publication of his book I actually shared several resources with him which clarify those problems with the theory) but goes to great lengths (I will examine them below) to give the impression that autogynephilia is somehow nevertheless a live option in the trans community but he somehow never gets around to mentioning the fact that, as a theory and as a category it has been roundly discredited by the psychological community. He does recommend Alice Dreger's book Galileo's Middle Finger (Dreger is a historian) for "a punchy review for some of the controversy surrounding autogynephilia" but fails to mention that Dreger is generally understood in the trans community to be transphobic and a supporter of quack pseudoscience. In fact all four of the people cited in the main text of this section (Alice Dreger, Ray Blanchard, J Michael Bailey, and Anne Lawrence) are all thoroughly anti-transgender partisans whose work has been thoroughly debunked.

Citation & Misrepresentation

I can't end this section without mentioning one last galling choice Dr. Sprinkle makes in this section. In footnote 12 Sprinkle provides citation for the claim that "Trans* people themselves hold a wide range of opinions on autogynephilia" by citing Julia Serano and Miranda Yardley. This is, of course, technically true inasmuch as it is possible to find someone in any category who believes almost anything. Trans people (particularly trans women) who believe that autogynephilia is a legitimate category of transgender person (and/or a real reason that someone might think they are trans without actually being trans) are, however, very much on the fringe. Thus, Dr. Sprinkle's habit of "listing views" without ever(?) distinguishing between mainstream and fringe views ends up subtly misleading the reader. Saying that "American women themselves hold a wide range of opinions on patriarchal polygamy" and then citing that with two specific women who have written on the subject would technically be a true statement but would give the misleading impression that patriarchal polygamy is a live option in the United States when it simply isn't. 

Dr. Sprinkle's choice of women to list as representative of the spectrum of views on this is itself rather a tell sort of cops to this problem. I have cited Julia Serano frequently in this series and will continue to do so because she is an excellent authority transgender theory in US, particularly among transgender women. Serano holds a PhD in Biochemistry and Molecular Biophysics from Columbia University, has published in multiple academic scholarly journals, and wrote the seminal book on transgender theory and feminism: Whipping Girl (A text Sprinkle has admitted to not having read prior to the publication of his book despite having been referred to on on multiple occasions); Miranda Yardley holds a bachelors degree in accounting, runs a music magazine, and has written some articles about trans theory on her personal website. These two sources are not equal, but none of that is going to be apparent to a casual reader of Embodied.

If this sort of misleading mischaracterization were a one off then I could reasonably be accused of nit-picking here. Unfortunately it is representative of Sprinkle's approach throughout the book.

Mental Health Concerns Among Trans*

It might seem a little bit precocious but I want to note that the titles for most of these sections are grammatically incorrect. "transgender" "trans" and even "trans*" are all adjectives. Just as it would be grammatically incorrect to say "Mental Health Concerns Among Short" it is incorrect to say "Mental Health Concerns Among Trans*". This is not, on its own, a serious issue but it does suggest that Dr. Sprinkle is not actually all that familiar with transgender people and transgender discourse. To the average cis person those grammar errors probably don't stand out much, but to a trans person they read like the glaringly bad grammar that they are.

As to the content of this section, despite its length, the problems are fairly easy to summarize. Sprinkle notes the well documented correlation between people on the autism spectrum and who have various mental health issues, and people who are trans. He then goes on to speculate rather oddly on the possibility of an autistic person who has OCD who "has an ongoing obsession with the idea of becoming the other sex". He then has a paragraph talking about making sure that people don't think they are trans due to factors actually rooted in a mental health concern or in their being autistic, and a final paragraph reminding his readers that: "It would be untruthful to assume that every biological male who identifies as trans* is autogynephilic or on the autism spectrum of has an underlying mental health issue" which is accurate enough but gives the impression that there is some significant portion of people who think that they are trans but are actually suffering from some mental health condition or are autistic and somehow confuse that for trans-ness. That theory doesn't hold up to the data we have about trans people now and it didn't hold up to the data we had when Sprinkle first published the book.

In general the enormous missing piece in Sprinkle's analysis in this chapter is the whole concept of minority stress which has already been document (and had well before Dr. Sprinkle wrote this book) to have a significant impact on the physical and mental health of queer people generally and transgender people specifically. In fact is now also well documented that affirming health care and social support can largely to totally mitigate any increase in mental health challenges transgender people might experience in contrast to our cisgender counterparts. The conclusion of this 2016 report (four years before Dr. Sprinkle published Embodied) from the American Academy of Pediatrics is worth quoting here:

Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group.

 Trans* As Internal Homophobia or Misogyny

The reasoning in this section is somewhat twisted. Sprinkle's basic thesis is that some people transition, not because they are trans, but because they suffer either from internalized homophobia or (in the case of some cis women) internalized misogyny. It is not clear to me how Dr. Sprinkle justifies calling these people "trans*" given that his definition of "trans*" would seem to preclude any category of people whose gender identity doesn't actually differ from the sex they were assigned at birth. If Preston Sprinkle wants to warn about cis people transitioning for bad reasons, that is one thing (though I would argue that the data I have been citing throughout this piece rather undercuts his idea that this accounts for any significant number of people who choose to transition) but it doesn't justify his categorizing people who don't fit his own definition of "trans*"ness as trans*.

It is worth saying the meantime, that the evidence he provides to support his assertion that the "story of [transness as] repressed homophobia is more widespread than you might think" consists entirely of a single cis lesbian who transitioned for a year and a single paywalled article from The Times which Sprinkle summarizes as "Some therapists wonder if certain parents who are highly supportive of their child identifying as transgender could be motivated by a homophobic fear about their child being gay" [emphasis mine]—hardly the sort of evidence that ought to be required for a robustly stated "is more widespread than you might think" from a professional academic. To be fair, Dr. Sprinkle does go on to provide adequate citation for his claim that Iran performs gender transition procedures and outlaws homosexuality but it is not clear to me how that reinforces a claim about what might motivate cis people in countries where homosexuality is legal and where trans people are more likely to face both social stigma, violence, and repressive laws than our queer cis counterparts.

As to the misogyny claim, Sprinkle's evidence consists entirely of a single anecdote and an online non-scientific survey (I was not even able to locate a methodology statement) which seems to have circulated primarily in anti-trans spaces. In fact when I googled the author and survey Sprinkle cites here (footnote 21 of Chapter 3) all I was able to find was a reference to a survey in a tweet from a Twitter account entitled "Detrans Voices" @FtMDetransed which provided two screenshots of a Google Forms survey and a link to request access to the Google Forms Survey. The author Sprinkle cites (Haley Mangelsdorf) seems to be either a ghost or a pen name as a search for that name brings up only a link to a zine which I have not been able to track down, and a reference to the survey on 4thwavenow a notorious anti-trans website and forum. It seems likely that Sprinkle got this source from one or the other of those sources, but it is odd that he would see fit to include this as a citation in his putatively academic text. 

Listening Love

This final section in the chapter starts of pretty well. Sprinkle's thesis for the section is that Christians need to be more loving towards trans people and I am all on board with that. Unfortunately he tries to illustrate the importance of that by going back to his story of Kat who detransitioned(2) after working with a woman at Kat's church who listened and responded with "I'm not sure. But I'd love to explore this with you" after Kat asked her What God thinks about transness and transition. I say "unfortunately" but it is also helpful that this provides a bit of a "mask off" moment in the book. The strong impression you get reading this section is that for Sprinkle, the goal of Christian interactions with trans people is for us to not transition. The second to last paragraph sums it up as:

Some people might enjoy being instructed by a person who seems to have all the right answers—a two-legged Google with a mouth that never seems to shut. But I think most people are like Kat. They want to know the truth, but they want to find it with a friend.

Preston Sprinkle wants his cis Christian audience to guide trans people away from transition or even really identifying as the women, non-binary people, and men that we are; he just wants them to be nice while they are doing it. You catch more flies with honey than vinegar after all. 

Series Index

Intro

Part 1—Chapter 1: People

Part 2—Chapter 2A: Terms

Part 3—Chapter 2B: Sex and Gender

Part 4—Chapter 3: Varieties of Trans 

Part 5—Chapter 4: Male, Female & The Image of God

Part 6—Chapter 5: Gender Stereotypes

Footnote

1. I have no idea why Sprinkle focuses on "the surgery" here since plenty of detransitioners detransition after taking HRT without any surgeries, while the regret rate for gender affirming surgery is only 2%. It seems that Sprinkle may be going more for shock value than for an accurate representation of the state of affairs. He spends some time speculating on the possiblity of and autistic person suffering from OCD

2. According to Sprinkle Kat identifies as transgender despite now identifying with the gender Kat was assigned at birth on account of still experiencing gender dysphoria. It is worth noticing that this does actually place Kat outside of Sprinkle's original definition of what it means to be transgender.  

The Sweetest Poisons: Preston Sprinkle's "Embodied" Chapter 2B Sex and Gender. A Review

This is the fourth installment in my series reviewing Preston Sprinkle's book Embodied: Transgender Identities, the Church, & What the Bible has to Say. Click HERE for the Intro to this series where I discuss my thematic concerns with the book and for an index for the full series.

In the second half of Chapter 2 Preston Sprinkle focuses in on defining and briefly exploring Sex and Gender. So let's do this.

Sex

Sprinkle has a lot to say about sex and, to quote him, "Not having sex, but biological sex" and that's fair enough. The thing that is often referred to as biological sex (1) is a really important concept in this conversation. He starts by saying that humans are sexually dimorphic and that that means that our species reproduces when the gametes of two different "kinds" of humans fuse. He then offers the first in a long list of varied definitions he provides, and seems to endorse, for "male" and/or "female" throughout this section. Here is the full list as best I can compile it (the following list are all direct quotes; italics + bold are my emphases):

1. The categories used to classify the respective roles humans play in reproduction are "male" and "female".
2. Females are distinguished from males based on their different reproductive structures.
3. Males and females also have different levels of hormones.
4. Genetically, the presence of a Y chromosome distinguishes males from females.
5. To sum it up, a person is biologically either male or female based on four things:
• Presence or absence of a Y chromosome
• Internal reproductive organs
• External sexual anatomy
• Endocrine systems that produce secondary sex characteristics
6. Feminist philosopher Rebecca Reilly-Cooper describes "female" and "male" as "general biological categories that apply to all species that reproduce sexually.
7. The American Psychological Association says, "Sex refers to a person's biological status and is typically categorizes as male, female, or intersex. There are a number of indicators of biological sex, including sex chromosomes, gonads, internal reproductive organs and external genitalia."
8. [A]n organism is male or female if it is structured to perform one of the respective roles in reproduction," and "[t]here is no other widely accepted biological classification for the sexes."(2)
9. Male and Female are categories of biological sex based on structures of reproduction.

After a number of read throughs of this section and the rest of the book, it remains unclear to me whether Dr. Sprinkle thinks that person's sex is based on a role or on certain physical characteristics. He is fairly clear later on that he doesn't think a person's sex can change even when some, or even a majority, of those characteristic change and typically people who hold that view want to reduce sex to the size of gamete a person produces—yes it is very strange to suggest that we can't know whether a person is male, female, or another sex category without measuring that person's gametes—and get a little vague on the topic of people who produce differently sized gametes or none at all. On the other hand the definition Sprinkle Provided—implying that he agreed—from the APA is probably the closest to what you would hear from trans and intersex people: sex references someone's status and that status is typically (not universally or necessarily) categorized as male, female, or intersex, and that those categories are indicated by a variety of physical factors. Honestly when I read it, Sprinkle providing that definition seemed out of place as it seems to undermine his repeated assertions that 1. Sex is binary and 2. Sex is clear (except for intersex people). I almost wonder whether he somehow glosses over terms like typically and variety of factors. 

For the record, I am inclined to accept and use Julia Serano's defintion based on it's similarity with the APA definition cited by Sprinkle and her qualifications as a PhD in biochemistry and molecular biophysics together with her own history of research and writing on this subject:

[W]ith regards to bodies, [sex] refers to a suite of sexually dimorphic traits that may include chromosomes, gonads, external genitals, other reproductive organs, ratio of sex hormones, and secondary sex characteristics...

For the purposes of making sense of  the book, I would suggest that Sprinkle most frequently means by sex and the related terms male and female, the definition he cites from Paul McHugh: 

[A]n organism is male or female if it is structured to perform one of the respective roles in reproduction

but let the canny reader beware: he will not be consistent and that definition is subject to change in places where Sprinkle needs a more expansive definition to make his argument work. 

Sprinkle's Bracketed Intersex People.

Much of the reasons for Sprinkle's inconsistent definitions of sex may be attributable to the approach he takes in this book to the existence of intersex people—he brackets them. To be fair, I think he wants to be nice about it. He says:

The topic of intersex [sic] has its own set of questions and assumptions. It'll be better to discuss intersex [sic] head-on rather than weaving intersex [sic] in and out of conversations about non-intersex people. So, for the next several chapters, I want to focus on humans who don't have an intersex condition. My motivation for doing so is to honor my intersex friends, not to sideline them. It's common for non-intersex people to invoke "intersex" as some faceless concept in service of an argument. But I find this practice rather dehumanizing to actual intersex people, and many intersex people do as well. I'd much rather talk about (and with) intersex people extensively in a separate chapter before considering how intersex [sic] relates to our conversation. 

Let's start by recognizing and appreciating that Sprinkle is (I will assume sincerely) attempting to prioritize and center the humanity and dignity of intersex people. That is a good impulse and something that is important to keep in mind. I have done some writing of my own on the subject and have been engaging with Sprinkle about it every since his review series of Megan DeFranza's Sex Difference in Christian Theology: Male, Female, and Intersex in the Image of God. The problem in this case is that Sprinkle's decision to defer questions about how the existence of intersex people impacts the definitions of of terms like sex, female, and male has the effect of distorting the conversation. Intersex people obviously complicate simplistic, binary, and reductive accounts of sex in the human population. Sprinkle tacitly admits as much with constant caveats that he is talking about non-intersex people and with his announcement in this chapter that he is postponing any discussion of intersex people for Chapter 7. Trying to define sex, female, and male while bracketing intersex conditions and then concluding that "[A]n organism is male or female if it is structured to perform one of the respective roles in reproduction" is bit like trying to define all animals as "mammals, birds, amphibians, and fish" while bracketing platypuses(3). When real beings don't fit the categories, we don't get to bracket them, we have to admit that our categories are imperfect and, if we want to have accurate and comprehensive categories we then re-do, or at least soften the boundaries of, our categories. You see this boundary softening in the APA and Serano's usage of qualifiers like suite of, typically, and variety of factors. 

By bracketing any incorporation of intersex people from his definition of sex, male, and female, Sprinkle erases those persons from having an impact on his argument at this point in the book, thereby justifying an over-simplified definition of key terms in the conversation. He is, in effect, cherry picking his human data and justifying it by deferring discussion of counter examples for a future Chapter. In principle that could be sort of technically acceptable if Chapter 7 itself were to somehow demonstrate conclusively that the existence of intersex people in no way impacts his conclusions here. But first Chapter 7 does not actually accomplish that, and second the effect is to leave the trusting reader with the impression that Sprinkle has made that case without actually exposing them to the argument. By the time the reader gets to Chapter 7 (I do wonder why it wasn't Chapter 3) Sprinkle's definitions of these terms are likely to have lodged in their mind as solid rather than as "provisional provided he successfully makes the case in Chapter 7" which would be the logically rigorous, and also psychologically difficult, way to read the text.

Conclusions on Sex

Beyond the above, Sprinkle meanders a bit (he briefly explores his best understanding of Judith Butler's claim that sex (and not just gender) is socially constructed but he ultimately rejects it on the basis of the "cold hard fact that sexual dimorphism exists in humans" a claim, depending on what he means by "sexual dimorphism"—he seems to be thinking of hermetically sealed categories rather than heavily populated poles along a dimorphic spectrum—, that can only work so long as he continues to bracket the existence of intersex people. His conclusion is fairly straightforward: "Our interpretations of sex and sexed bodies might be socially constructed, but sex itself is not socially constructed". Honestly I suspect he simply doesn't actually understand the philosophy involved and what it means to "assign meaning" to a phenomenon. At any rate he then moves on to gender.

Gender

Sprinkle opens this section first by saying that the distinction between sex and gender only goes back as far as the 1960s—a claim I would like to see some evidence for since C.S. Lewis made the distinction in 1946 and it may well pre-date that significantly we we recognized that the concepts themselves may have been expressed in different terms—which transition him to what he calls "the most basic and widely agreed upon definition of gender" which he takes from Mark Yarhouse:

The psychological, social, and cultural aspects of being male or female

In a footnote he claims that this is widely accepted by scholars. I don't love it but he is probably correct about it's general acceptance. He then breaks the definition down into what he says are "two different (yet overlapping) categories": gender identity and gender role. 

Before I get to an analysis of his reflection on those terms though, I want to quote Serano's definitions both since they are closer to what I would use and so you can hold them in apposition to what Sprinkle has to say.

Gender Role: a term that has been used in psychology to describe the various roles that one is expected to fulfill in society or within relationships based upon their gender status; this might include specific behaviors (e.g., acting masculine, feminine) or more formal interpersonal roles (e.g., father, mother, boyfriend, girlfriend). This phrase is used less frequently today, and has been largely replaced by (or subsumed under) the term gender expression.

Gender Identity: the gender that one identifies as. The term originated in teh field of psychology where it is generally understood to be distinct frm an individual's sex (i.e. their physical body), as well as their gender role/gender expression (i.e., outwardly-directed gender-related behaviors). While most people in our culture identify as either a boy/man or girl/woman, others come to adopt non-binary gender identities. In Whipping Girl (pp. 77-93) I introduced the term subconscious sex in order to distinguish between the conscious and deliberate act of idenitfying with a particular gender, and the more unconscious and inexplicable self-understanding of what sex/gender one should be (the latter of which many trans people experience prior to explicitly claiming that gender identity).

Gender Role

Sprinkle's treatment of this term, which he describes (he doesn't really define it) saying:

Gender roles have to do with how males and females are expected to act in any given culture.

I don't really take significant issue with his description so rather than a point-by-point analysis of his reflection on it I want to offer a few top-line observations and one critique of his sourcing for this section. 

First, I am not at all clear on why Sprinkle decided to use the term "Gender Role" rather than "Gender Expression". It may have some ideological basis (he doesn't really refer to the latter term), perhaps based in a desire not to present the concept as emerging from, or being rooted in, a person's gender identity, or because he is getting ready to talk about John Money who is thought to have coined the term; it may be as simple as the fact that his research and reading seems to have been disproportionately weighted towards TERF and trans-denying accounts which are potentially more likely to have used the term, but it isn't clear. It is odd for him to have chosen the less common, and largely outdated term though.

Second, throughout this section, Sprinkle plays pretty fast and loose with a sort of impression that trans people's concerns are significantly formed by "Gender Role" expectations. Now it is absolutely the case that navigating and working out how we relate to existing cultural expectations regarding our gender expressions (the way we live out our gender) is a significant subject for trans folk. My concern is that Sprinkle is overplaying it to the point that one might expect after reading this section to hear that trans-ness at least can consist only in wanting to have a non-standard gender expression while still having a cisgender identity. And in as much as there may be some people who identify cis-ly but feel drawn to non-standard gender expressions and identify as trans on that basis, those folks just kinda aren't what the conversation generally and in this book is actually about—remember that Sprinkle says the central question for the book is "If someone experiences incongruence between their biological sex and their internal sense of self, which one determines who they are—and why?" and that "internal sense of self" references not gender expression but gender identity. I have to notice, then, that the time Sprinkle spends on this topic and on decrying oppressive gender stereotypes and establishing himself as affirming a far wider-than-is-common-for-Christians vision of expansive gender expressions (I would agree with him on those points) will end up serving as a serious foundation for his regurgitation of harmful TERF talking points later in the text when he makes the move to question whether gender identity may not actually just me a desire for serotyped gender roles. In short it isnt' that I particularly disagree with him in most of this section—I would quibble with a few phrases—it is that I am, by now, suspicious of what he is doing with it.

Finally it stood out to me, and not in a positive way that Sprinkle devotes a significant part of this section to the story of David Reimer. On the one hand, that seems almost inevitable. The rather tragic story of David Reimer is a sort of touchstone for nearly everyone who wants to talk about trans people. The appeal is, is suppose, obvious. David was a twin who suffered an accidental injury to his genitals as an infant. Dr. John Money—about whom everyone has a lot to say—convinced David's parents to try raising David "as a girl" on the theory that gender is entirely a social construct and that children who are raised "as girls" will adopt that understanding of themselves. It went horribly wrong, David quickly and early on asserted himself as a boy and at 14 he detransitioned from a forced "role" into his own gender identity—that of a boy. He then continued to live his life in his gender identity until his tragic suicide which is generally attributed to his complicated childhood. 

Everyone wants to draw conclusions from the David Reimer case. It is s a sort of obvious go-to for Nature/Nurture debates (which is how Sprinkle deploys it) but it is often cited by trans affirming folk as evidence that gender identity persists regardless of how a child is raised (thereby challenging various claims made by people who think trans-ness can be treated out of us) and it is sometimes rather ham-fistedly deployed by anti-trans people as a sort of "any transition type treatments of youth are bad". Sprinkles use is mostly just to sort of point to it and observe that neither nature or nurture seem to give the whole story on the subject of gender. What I find concerning is first that he put it in this section (geneer role) rather than the next (gender identity) and second that he seems to have made a point of portraying Dr. Money as a sort of pro-trans researcher. Money was complicated but is in no way broadly accepted or celebrated in the trans community and it isn't great seeing Sprinkle hanging him around our necks.

But it is after all of that that we get to the heart of this chapter. Preston Sprinkle's reflections on gender identity.

Gender Identity

Buckle up.

Sprinkle starts off relatively well. His immediate definition of the term is "one's internal sense of self as male, female, both, or neither" and he cites (for once) solid sources (name the Human Rights Campaign an Austen Hartke. He pretty much goes off the rails from there. 

More than any part of the book to date, I think this section highlights the paucity of Sprinkle's research into what mainstream trans folk are actually saying and the distortions in reporting that result from that. As I have remarked elsewhere, I don't have any clear way of determining whether Sprinkle was just lazy/unconsciously motivated in his research or was aware of the broader conversation, perspectives, and accounts that his book ignores and simply chose to suppress them. Either way the effect is a read that probably makes sense to cis people who don't have a lot of trans people in their lives but comes across as alternately confused and alarming to actual trans people.

Sprinkle organizes his reflections into four questions.

Does Gender Identity Exist?

He concludes the two paragraphs he devotes to this section by tabling it as requiring more exploration to answer. The rest of the two paragraphs are almost entirely devoted to highlighting the voices and positions of people who say that gender identity is not real and expressing his concerns. He does follow that with an acknowledgement that "there are some biblical and scientific arguments for gender identity being a more ontologically robust aspect of human nature" but instead of even listing them—much less explaining them with the detail he used for the anti-trans arguments—he just tables the discussion.

The effect is to leave the reader dubious about even the reality of gender identity without giving them even a representative experience of "the debate", hardly an open minded position from which to evaluate the rest of what he says about the topic.

In fact, if Sprinkle had done his reading he would have encountered the works of trans theorists who enunciate (in the vein of Serano above, but Talia Bettcher, Sandy Stone, Justin Sabia-Tanis, even Contrapoints or Abigail Thorn would have clarified it as well) an explanation that gender identity designates an experience that we largely hold to be very much real while recognizing that (at least for the time being) the experience of a person's gender identity is available only to that person. It is just a fact of human existence (consult your own) that there are some experiences which we have but which we cannot grant outside observers access to. For instance, if I were to take Sprinkle's approach in this section but apply it to the concept "being a Christian" I would observe that many Evangelicals mean by being a Christian that they have accepted Jesus into their heart or that they will sometimes use the phrase believing in Jesus. "But" I would argue, "there is no caridographic instrument that will show us Jesus in a heart and there is no brain scan that can demonstrate that a person believes in Jesus—we can't really even know what they mean by 'Jesus' there: a historical figure they have only read about? a person they have only spoken to or experienced as an inner feeling? Honestly there seem to be as many versions of Jesus floating around as there are Evangelicals who say they believe in him." The irritated Evangelical would likely respond that the experience of believing in Jesus—having him in their heart—is very real even if it can only be known subjectively. 

The fact of the matter is that there just are a certain set of experiences which are only available to the person who has them and, as many trans people and philosophers have pointed out, a lack of external verifiability does not indicate that a claim is false.

In any case and for the record, my response to the question is that, yes, gender identity does exist, that it is a thing we all can know subjectively and which has very real and verifiable impacts on each person. I would add that cisgender people, those whose gender identity easily or comfortably aligns with the sex they were assigned when (or before) they were born, have a hard time "locating" it for the same reason that we are less likely to constantly notice comfortable, well fitting, clothes but are constantly aware of pinching, ill fitting clothes: unless something seems to not fit, the whole thing is processed in the back ground at a pretty deeply subconscious level. 

 

But having cast a significant shadow over the concept as a whole, Sprinkle moves on to:

How Many Gender Identities are There?

I don't see why Sprinkle thinks this is an important question to ask at this point. Rather, I can't think of a compelling good faith reason why he would. The effect that this section has—Sprinkle spends it first positing that there may be as many as ten thousand gender identities and then rather ironically reminding the reader that we need to make sure we know what people mean by the terms they use—is to give the impression of a sort of arbitrary gender chaos without giving any real consideration to what is meant by people who talk amount a multiplicity of gender identities and why they make those claims. What is so difficult to explain away is the clear contingency of this question: What does it matter how many gender identities there are before we have established whether or not genders identities are real in the first place? Even then, Sprinkle doesn't really explore the particularities of different gender identities anywhere in the book, so why should it matter to him how many there are if the answer has no bearing on what he has to say? 

The answer that springs to mind isn't charitable so please take it with a grain of salt. The only reason I can see for Sprinkle including this question at this point is to give himself an opportunity to portray gender identity as vague and a bit ridiculous in in the mind of his readers.

How do you determine a person's gender identity?

On this question Sprinkle only responds that there are a range of views and he locates self-id at one side of that range and transmedicalism at the other side. From various podcasts (and somewhat in line with Mark Yarhouse's "Least Invasive Treatment" approach) I know that Sprinkle takes a sort of begrudging transmedicalist-as-last-resort-and-if-nothing-else-will-work position on the question of transition and that likely has a bearing on the way he thinks about that range of views. 

I will note before moving on that Sprinkles' "If you identify as a woman, then you're a woman. There is no objective criteria that need to be met" line when describing the self-id position is rather dismissive. 

Is gender identity malleable?

This comes right at the end of the chapter, is very brief (81 words) and contains no citations whatsoever so I don't really have any insight into the justification for Sprinkle's claim in it that: 

The fact is—and it is a fact—for some people gender identity changes, and for other it doesn't. This shouldn't be surprising. After all, we're dealing with "one's internal sense of self."

Sprinkle is on the record as still believing that conversion therapy (though he doesn't like it being called that in this instance) is a real and positive option for "people who experience gender dysphoria" and beyond holding open room for that heinous view I don't know that Sprinkle is accomplishing, or trying to accomplish much here. 

As for the claim itself, the truth is significantly less cut and dried than Sprinkle seems willing to admit. Put another way, the word "some" is doing a lot of heaving lifting in his claim.  Sprinkle sums up the section and chapter by promising to revisit each of these questions in more depth later in the book, once more effectively giving himself a sort of permission to have done a sloppy job with them here while also establishing a degree of doubt in his readers minds about the claims of trans people. 

Series Index

Intro

Part 1—Chapter 1: People

Part 2—Chapter 2A: Terms

Part 3—Chapter 2B: Sex and Gender

Part 4—Chapter 3: Varieties of Trans 

Part 5—Chapter 4: Male, Female & The Image of God

Part 6—Chapter 5: Gender Stereotypes

 

Footnotes:

(1) There isn't really a perfect term for the thing he is trying to get at and hopefully the reason for that will become clear over the course of this series. I would argue that sex is only the physical manifestation of gender but my take on that is not mainstream in even transgender Christian discourse.

(2) He cites Dr. Paul McHugh for this claim and that is more than a little problematic for several reasons. First because Dr. McHugh is a really problematic source, and second because in this interview conversation he had with Christina Beardsley on the Unbelievable? podcast, he takes offence and pushes back when she lists Dr. McHugh among his sources, she apologizes and qualifies that other in Sprinkle's camp cite McHugh and he sort of harumphs back something to the effect of "others but not me". Meanwhile in the book they are talking about he had specifically cited McHugh to define a term he identifies as crucial to understanding the topic.

(3) Platypus as a word is in a class of English words (along with octopus and a few others) with Latin sounding Greek roots. The result has been considerable misinformation about the proper pluralization of these words in English. If the word were derived from Latin, the correct plural would be Platypii or something of the sort, but when English incorporates words from non-Latinate languages the practice is to either keep the original pluralization (the classical Greek knowers in my life tell me this gives us something like Platipodes) or to use the standard Germanic English pluralization. Hence, Platypuses.

The Sweetest Poisons: Preston Sprinkle's "Embodied" Chapter 2A Definitions. A Review

 This is the third installment in my series reviewing Preston Sprinkle's book Embodied: Transgender Identities, the Church, & What the Bible has to Say. Click HERE for the Intro to this series where I discuss my thematic concerns with the book and for an index for the full series.

In Chapter 2 of Embodied Preston Sprinkle defines his terms. Or, at least, he defines some of them. He opens with a reasonable caveat that there are lots of terms and he recommends "the internet" for the ones he doesn't include in this chapter. To that end, here is a link to GLAAD's media reference guide for trans related terms, and here is a link to the HRC's glossary. He also makes it clear that these are going to be substantial definitions  and that the terms sex and gender will take up a half of the chapter. Chapter 2 is really both definitions and Sprinkle's initial reflection on those terms and their definitions. 

Before I launch into an analysis of Sprinkle's take on these terms, I want to recognized that many
debates and arguments are won or lost on the basis of definitions. An argument or position built on a definition of key terms will often fall or stand depending on the careful definition of those terms and, for that reason, in a good faith discussion it is important to agree with your interlocutor up front about what the key terms mean and how you will be using them. A small difference in the definition of a few key terms may be minor at the outset but as the lines of argument built on them extend, the distance between what is said and what is heard can grow significantly. Thus it is important to be clear about terms as we dive into the book.

For those reasons, this installment is only going to respond to the first half of Chapter 2. Sprinkle's definitions and statements are...let's say problematic... and it is going to require a good deal of space to respond.

Most of the Terms

As I hope will be clear by the end of this section, Preston Sprinkle is either sloppy in his research or a disturbingly motivated reporter throughout the text and no less in this chapter. Sprinkle provides a total of 5 footnotes to the first half of this chapter and only one (for "transgender" where he cites Mark Yarhouse) cites or uses a definitional source for the terms he uses. Instead Sprinkle provides his own definitions. The effect of this is to allow Sprinkle to present himself in this chapter as a teacher, helping the reader familiarize themselves with the technical jargon of this subject. But that mode of writing disguises (and Sprinkle only alludes to this when he absolutely has to) the extremely contested nature of a lot of these terms. Specifically because arguments and then positions are built on the definition of words, trans people are extremely careful in our usages of relevant vocabulary. Every single one of the terms Sprinkle lists and reflects on is presented in a way that differs from the definition and/or explication of it that you would encounter reading a text by a transgender person. 

And that leads me to my second top level observation of this chapter, one that will resurface again and again as we work through the book: Sprinkle uses "debated-ness" in an almost entirely one sided way. When he encounters scholarship or terminology that he doesn't like he is quick to highlight any debates or contention about it before stating his position. He will sometimes provide a citation for the debate but even when he does his sources is nearly always wildly unbalanced in favor of his position. In contrast whenever possible he seems to have avoided mentioning debates or contentions that would tend to challenge his position or the usage of his terms. His bias for a particular set of conclusions is hidden by his tone and the unbalanced nature of his citations which has the alarming potential of leading the reader to misapprehend the state of the discussion by and about trans people. 

Transgender

Sprinkle actually chooses to defer any in-depth discussion of this term for Chapter 3. For the purposes of this chapter he provides Mark Yarhouse's definition: An umbrella term for the many ways in which people might experience and/or present and express (or live out) their gender identities differently from people whose sense of gender identity is congruent with their biological sex. Beyond that he really wants to stress the "umbrella" nature of this term. And on one level, that's fair—"transgender" is indeed importantly an umbrella term—but on another level, he is setting up to engage in the sort of slippery rhetoric that I identified in my introduction to this series and which I will have a good deal more to discuss as he explains some of his thinking when we get to Chapter 3.

Nonbinary

Here again, Sprinkle highlights that the terms is an umbrella term and provides a fully adequate explanation of what binary entails and that nonbinary designates trans identities which are not binary. He then rather dismissively lists genderqueer, genderfluid, and pangender as sub-categories of non-binary identities. He doesn't offer any clarity into the difference between those three identities.

And then he digresses: 

To be clear, all non-intersex(1) persons (and most intersex persons, as we'll see) are biologically male or female, regardless of how they identify.

He goes on to say that the various non-binary identities designate something about the person's relationship to the categories "masculinity and femininity" or it indicates "that they experience some level of incongruence between their bodies and their minds". He then suggests that all of this well be less confusing when he unpacks sex and gender. But I have a little more to say at this point.

What Sprinkle is doing, with a light touch here, is setting up a critique he will be leveling at trans folk later on. It is a critique based primarily in TERF allegations against trans women (though it is used against trans men and non-binary people as well) and boils down to the idea that we reinforce harmful gender stereotypes. This is a wildly off base accusation based, usually, in not having interacted with more than a handful of trans people. I will respond to it when he finally makes the accusation but for the time being let us just note his decision to highlight the "don't fit into strict categories of masculinity and femininity" bit. Here he seems to be widening the umbrella a little farther than trans people actually do. I don't know that I have ever encountered a trans person who rejected the possibility of a tomboy or a feminine guy as fully cisgender identities, but by Sprinkle's definition here those folk (who may be more or less varied in the expression of their gender identities based in cultural gender assumptions) would seem to be categorized as non-binary and therefore trans.

Trans*

Sprinkle's justification for using trans* with the * is brief:

Since so many gender identity terms can overlap with each other, some people put an asterisk after the word trans, styling it as trans*, when they want to us it as a broad umbrella term to include a whole range of identities that aren't strictly transgender, such as nonbinary, genderqueer, and the like. I'll do the same in this book. [emphasis original]

I don't know who these people are (and Sprinkle declines to cite the claim so I have no way of knowing whom he has in mind here). In my experience, and as I discussed in the intro to this series, people who want to use trans as an umbrella term just do, they don't add an *. More strange to me was Sprinkle's suggestion that non-binary and gender queer folk aren't strictly transgender. I am of the impression that there is some variation in which people with those identities choose to identify, or not, as trans but simple declaring them not "strictly transgender" isn't anything I have seen in mainstream trans discourse. As one non-binary friend of mine responded, "Sprinkle would have done far better to have simply observed that some non-binary people identify as trans while other don't"

Gender dysphoria

Sprinkle's definition of this term is great:

Gender dysphoria is a psychological term for the distress some people feel when their internal sense of self doesn't match their biological sex.

For sure, he doesn't cite that definition from any particular source but it is fairly standard. And after this paragraph Sprinkle proceeds to give us three heart wrenching descriptions, all first hand accounts, of the experience of gender dysphoria. Again this is perfectly reasonable in a text of this sort. 

Unfortunately between the definition and the examples, Sprinkle sneaks in this little false claim which I will have to respond to:

As a diagnosis, Gender Dysphoria used to be called Gender Identity Disorder, but the name was changed to Gender Dysphoria in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th edition) in 2013.

This is a common enough misconception but it is decidedly wrong and a text on the subject of transgender people absolutely ought to know better. With even a little bit of research, Dr. Sprinkle would have found that

With the publication of DSM-5 in 2013, "gender identity disorder" was eliminated and replaced with "gender dysphoria." This change further focused the diagnosis on the gender identity-related distress that some transgender people experience (and for which they may seek psychiatric, medical, and surgical treatments) rather than on transgender individuals or identities themselves. [emphasis mine]

That is from the American Psychiatric Assocaition's Guide for Working With Transgender and Gender Nonconforming Patients it took me all of 2 minutes to google. The difference between reality and Sprinkle's claim should be clear but in case it isn't, the shift from Gender Identity Disorder to Gender Dysphoria as the "core" diagnosis for trans people who seek therapy designates a shift from seeing the identity or the person as the problem in need of treatment to the distress generated by the experience of gender incongruence. With the old diagnosis the person or their identity was the problem; with the update, it is the distress that is the problem. That is not at all insignificant. 

Transition

Sprinkle opens this section by saying that transition "is the term most trans*[sic] people prefer for what is sometimes called "sex change." In fact transition is a larger category (and Sprinkle is about to acknowledge the range of the the term) than "sex change" ever was. Again it isn't a huge thing but I want us to notice that by locating the distinction between the two terms in what trans people prefer rather than in a technical difference, Sprinkle is adding one more little bit to his argument (intentional or not) that trans people and trans identities are all about feelings and that we are not making defensible truth claims. 

Sprinkle then goes on to accurately identify social transition, hormonal transition, and surgical transition as three categories of transitioning. It is more common in my experience to see these categorized as social transition and medical transition but I see no need to quibble. 

• Social Transition Sprinkle describes as typically dressing and acting as the sex with which a trans person identifies. This is a little weird as he is about to set himself against the idea that there are forms of dress and behavior of a given sex, but overall it is not egregious. He also mentions new names and pronouns as included in this form of transition

• Hormonal Transition in Sprinkle's view "means taking high levels of hormones typically produced by the opposite [sic] biological sex: those transitioning to male take testosterone, and those transitioning to female take estrogen(2). I don't really know why Sprinkle insisted on "high levels of hormones" other than to make Hormone Replacement Therapy (HRT) seem more dangerous than it is. The general goal for binary trans people who are on HRT is to have hormone levels that mirror those of their cis counterparts. If I were to find that my estrogen levels were significantly higher than the standard range for cisgender women I would be alarmed. 

Sprinkle then goes on to say that this intervention "is called 'cross-sex hormone therapy' (CHT) or 'hormone replacement therapy' (HRT or  HT). I don't know a single trans person who calls it CHT or HT, we pretty much universally (to my knowledge and in my experience) refer to it as HRT. And yet Sprinkle will refer to it as CHT for the rest of the book and I can't help noticing that this serves to emphasize the "cross-sex" element rather than the therapeutic element of this medical procedure. He doesn't justify the choice but by now I can't help being suspicious.

• Surgical Transition is one Sprinkle gets wrong right off the bat. He says that it "goes by various names: 'gender confirmation surgery' (GCS), 'sex reassignment surgery' (SRS), and a few others." In fact, and he halfway alludes to this further into the paragraph, surgical transition designates all the surgical procedures that a trans person might undergo as part of their transition including but not limited to GCS. He instead tries to lump some of those other surgeries—top surgery, ffs, etc—under the rubric of GCS/SRS after acknowledging that each term has ideological justifications. He makes a hash of it, and his reference to facial feminization surgery and top surgery as "cosmetic" is just inaccurate—those surgeries are medically necessary (when prescribed) therapies for the treatment of gender dysphoria; they are not cosmetic.

Transman and Transwoman

These are terms where what I am going to call Sprinkle's "reporting bias" really comes into play. Sprinkle gives two paragraphs to state that transman is "a biological female [sic] who identifies as male" and that transwoman is "a biological male [sic] who identifies as female". And he adds that these terms are sometimes "shortened as FtM (female to male) for transmen [sic] and MtF (male to female) for transwomen". 

All of that is...wrong? Or rather it is wildly distorted specifically because it omits a lot of relevant information. In fact the terms transman and transwoman written in that way are deeply controversial and have been rejected by the mainstream of transgender discourse. The correct expression of these terms are, respectively, trans man and trans woman (or transgender man and transgender woman) separated into the distinct terms "trans" and "man/woman"(3). This may seem like a minor distinction from the outside but, in fact, the distinction holds significant ideological value. 

In English "transgender/trans" is an adjective. Placing it as a word before "man" or "woman" indicates the sort of man or woman we happen to be talking about so that "trans man" indicates a man who is trans, and "trans woman" indicates a woman who is trans just as "short man" indicates a man who is a short and "short woman" indicates a woman who is short. In contrast the terms transman and transwoman are neologisms which seem to designate not types of men and women but novel categories. It would be odd to encounter a text in which there are men and then also there are shortmen and I imagine that short men would be inclined to take ideological umbrage with such a text arguing that they are men and not some novel new category. The same argument is made by trans people. I am a trans woman because I am a woman and "trans" designates the type of woman I am. I am not a transwoman because I am a woman just as I am not a christianwoman because I am a woman who is a Christian. 

Now it will become clear to any reader that this ideological divide is what actually forces Dr. Sprinkle into the transman/transwoman formulation. He does not believe or grant that trans women are women, that trans men are men or that non-binary poeple are non-binary. Thus for him to use "trans woman" would be to impute a status to me (womanhood) that he does not believe I possess. 

On one level, then, Sprinkle's choice to use transman/transwoman makes sense. It allows him to use terminology which communicates the object of his writing without granting a premise he will not allow. And if he had only acknowledged as much this critique would have been little more than a footnote. Instead Sprinkle doesn't even mention the controversy or justify his choice despite using what are clearly non-standard forms. There are two explanations I can think of and neither is especially reassuring: on the one hand Sprinkle may have chosen these terms and neglected to mention the distinction because he was unaware of the controversy and it's meaning. The research citations in his book evidence far more reading in the trans-denying corpus where the versions Sprinkle uses are routinely deployed and thus he may simply have not done enough research to be aware of a basic terminological distinctive; or Sprinkle may have known about the controversy but chosen to ignore it in an effort to suppress contrary views to his own in this text. 

On a final note it does also need to be said (referring back to Sprinkle's initial explanation of these terms) that "MtF" and "FtM" are, not at all "shortened" versions of the terms he claims to be defining. They are specialized terms used only as necessary (and generally frowned on even then—I am not "an MtF" I am a woman who is trans) to designate both the gender that a given trans person was assigned and the gender they actually are. I can't think of a reason beyond either sloppy research or sloppy writing for Sprinkle to have suggested that they are.

Cisgender

Sprinkle's bit on this term is both short and important enough to justify quoting in full:

Cisgender is a recent term that refers to those who identify (and are comfortable) with their biological sex. (Cis means "on the side of.") Basically, cisgender refers to everyone who doesn't identify as trans*[sic].

Since the term sometimes comes with ideological assumptions and connotations, I'll avoid it in this book unless the context or quote demands it. Instead, I'll use the more neutral term non-trans* to refer to people who don't identify as trans*

I have... a lot to say. First, of course, it has to be noted that when Sprinkle feels the need to justify avoiding a term, he is quick to highlight that it "comes with ideological assumptions and connotations"—trransman/transwoman do too but he didn't bother saying anything there, just smuggled in the "ideological assumptions and connotations" that happen to support his position. Second, beyond that (hypocrisy? academic sloppiness? motivated reporting?) I want to highlight Sprinkle's claim that cisgender refers to... "everyone who doesn't identify as trans*". He will, in fact, go on to include all sorts of people who by his own account here would otherwise fall under the category cisgender or non-trans*.(4) Third, I think we see here one (there will be more) weakness of Sprinkle's not having read Julia Serano's Whipping Girl.(5) The book was first published in 2007 and in it, Serano discusses uses of the term extensively. She identifies the terms as one that was coined in 1995 and was in the course of gaining currency between 2005 and 2007. She also provides significant discussion of the term, none of which Sprinkle shows evidence of understanding.(6) Of course "recent" is a relative term so Sprinkle's use of it here can, of course, be justified. With that said, by all accounts transgender studies is a rapidly developing field such that a term that has been in mainstream use within our community for more than fifteen years now, is hardly a "recent term"; in any case many of the terms Sprinkle uses throughout this book are far more recent.

But most importantly, while Sprinkle did identify the fact that the term cisgender "comes with ideological assumptions and connotations" he declined to identify them and I suppose that means it falls to me. 

Much of this analysis is taken from Whipping Girl and from Serano's subsequent work on the subject. in essence cisgender, by providing a complimentary term to transgender, gives all of us the capacity to talk about ways in which cis-ness impacts the way people experience and process reality. It makes cis-ness a thing and in so doing situates it as one potential option describing ways in which people related to the gender they were assigned at birth. Serano provides the following Koyama quote which nicely summarizes the utility of the terms cisgender, cissexual, and cissexism: 

...they de-centralize the dominant group, exposing it as merely one possible alternative rather than the "norm" against which trans people are defined. ... I felt it was an interesting concept - a feminist one, in fact - which is why I am using it.

In sum, cisgender "comes with ideological assumptions and connotations" because it implies that trans people are not freaks but one variation in the human experience and that cisgender people are likewise another variation. Those are the assumptions and connotations that Sprinkle wants to avoid. 

Intersex

Sprinkle defines Intersex  as "a term used to describe the sixteen or so medical conditions where a person is born with one or more atypical features in their sexual anatomy or sex chromosomes". It is not clear to my why Dr. Sprinkle sees a difference between "sexual anatomy" and "sex chromosomes". He then identifies "differences/disorders of sex development" as "the medical term for intersex conditions". His reflection on the term largely punts to Chapter 7 which is devoted exclusively to the topic, but thinks it is "important to know two things" now:

(1) Intersex is different from transgender. (2)  Ninety-nine percent of people with an intersex condition are biologically male or female (and the other 1 percent are both). In other words, intersex does not mean "neither male nor female".

He then moves on to sex and gender which I will cover in the next part of this series, but before I can move on from this topic (I will address his stance on intersex people fully in my own review of chapter 7) I need to very clearly state that both (1) and (2) there are complicated and much discussed topics in the intersex and trans communities (the existence of brain sex theory really complicates (1), and (2) is an ongoing discussion within the intersex community, various intersex individual understand themselves and their relationship to sex/gender in a significant variety of ways.

Series Index

Intro

Part 1—Chapter 1: People

Part 2—Chapter 2A: Terms

Part 3—Chapter 2B: Sex and Gender

Part 4—Chapter 3: Varieties of Trans 

Part 5—Chapter 4: Male, Female & The Image of God

Part 6—Chapter 5: Gender Stereotypes

 

Footnotes:

(1) I find it rather peculiar that Sprinkle chooses to use the - in "non-intersex" but declines to do so in non-binary where he uses the formulation nonbinary. If there is some discussion about this in non-binary circles please let me know.

(2) In point of fact, while trans men do typically take testosterone, trans women will typically take a testosterone blocker, estrogen and often progesterone until and if the blocker becomes...unnecessary.

(3)GLAAD maintains a media reference guide for publishing about trans people and, notably, it includes the separated form of the terms, and notes that "trans woman" rather than transwoman is the correct form

(4) The question of whether or not a person who chooses not to identify as trans but who bears certain distinctives of trans people (such as a person who identifies as gender dysphoric but rejects the label trans) are, or should be referred to as, trans is a complicated one and I am not in a place to suggest an answer. It is very much still being discussed. My inclination is to try to use the terms for people that they choose and I would be personally loathe to, in any serious way, assert that someone who rejects the term is trans.

(5) For the record, Serano also supplies us with an extensive glossary of trans related terms—one that Sprinkle would have done well to have consulted for this chapter so that, even when he deviates from the terms or definitions she supplies, he would at least have written the chapter with an awareness of how these terms and ideas are more frequently expressed and used among trans people. 

(6) Notably, Serano cites Emi Koyama as the source from which she first encountered the word and Koyama's citation is the one that identifies a 1995 coinage by trans man Carl Buijs. Sprinkle has interacted with Koyama's work as some level (he cites Koyama's work in his Chapter 7: "What about Intersex"—Koyama is an intersex feminist activist) but seems to be ignorant on this count.